Parliament’s health and social care committee is the latest body to warn about the decline of NHS dentistry. In a new report, the MPs say that the problem of so-called dental deserts – where it is impossible to register with an NHS dental practice – is getting worse rather than better. About 3,000 dentists have left the NHS since the start of the pandemic. Shortages are particularly acute in the east of England, where there is nowhere to train. Lincolnshire is among the counties with the lowest number of dentists, and people living there report having to travel for hours to find a dentist to treat them.
One study found that 90% of practices nationally were not accepting new NHS patients. Those affected include pregnant women and children, who should be able to access free care (most other people contribute to the cost of treatment). There has also been a steep decline in the ability of care homes to provide dental care for residents. From 67% in 2019, the number of providers who say they have access to dentists fell last year to just 35%. In one survey, 8% of people said that they had not seen a dentist for more than 10 years.
There have been alarming reports of DIY tooth extractions, using pliers, while a survey of school nurses and dentists found that more than three-quarters had seen an increase in tooth decay or damage in children. While teeth are the most obvious worry, there are wider issues around oral health, including mouth cancers. Poor dental health in older people is associated with malnutrition.
The government knows that the situation is dreadful. Hence Rishi Sunak’s announcement last month that ministers and NHS bosses would consider a “tie-in” period for new dentists, although not for doctors. This is when the newly qualified are required to work for a particular employer for a specified period, in return for the investment made in their training. In this case, dentists would be required to work for the NHS.
In parallel with plans to expand the roles of nurses and pharmacists in primary care, it is also proposed that more dental care will be provided by hygienists and therapists, instead of dentists. The rules on registration for dentists qualified overseas (currently about 25% of the total) have been revised, with a view to speeding up the process.
The elephant in the room is the dental contract, which was introduced in 2006, and, despite poor results, has only been slightly adjusted since. The criticisms made of it by the health and care committee, which include the lack of incentives for preventive action, and a flawed system of payments, are not new. But worryingly, the contract is not mentioned in the recently published NHS workforce plan, and the expansion of training places will take time. MPs are also concerned that dentists are not adequately represented on the new integrated care boards, which are responsible for commissioning care on a regional basis.
This should be remedied, and urgent research on the workforce carried out. It is simply not acceptable that dentistry has to such a large extent been privatised, and that so many people find themselves unable to access the care they need. The lack of a service for children, as they go through the rite of passage of losing baby teeth and growing adult ones, is a disgrace. Teeth require care from trained professionals, like the rest of people’s bodies.
